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Mental Health

Authors: Szilagyi PG, Shenkman E, Brach C, et al.
Date: 2003.
Title: Children with special health care needs enrolled in SCHIP: patient characteristics and health care needs.
Publication: Pediatrics 112(6 Pt. 2):508-20.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO17).

Authors: Revicki DA, Kobayashi M, Palmer CS, et al.
Title: Burden of schizophrenia in Japan: Impact on patients, families and society.
Publication: Schizophrenia Frontier 2(41)41-49.
Date: 2001
Abstract: Schizophrenia places a significant financial burden on Japanese society and the health care system. Patients with the disorder suffer stigma, impaired functioning, disability, and decreased quality of life and family members caring for relatives with schizophrenia suffer a financial burden, and psychological distress and caregiver burden. The newer atypical antipsychotics not yet commonly available in Japan may help improve patient functioning and quality of life, enabling fuller benefits from psychosocial programs, and reintegrating patients as productive members of the community. There are opportunities to benefit patients, their families, and society through improved treatment and provision of community-based services for schizophrenia.

Authors: Leidy N, Elixhauser A, Rentz AM, et al.
Title: Telephone validation of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89).
Publication: Epilepsia 40(1):97-106.
Date: 1999
Abstract: This study assesses the psychometric properties of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) administered via telephone and to compare these properties with data gathered through self-administration. Results of this study indicate telephone interview is a viable option for evaluating health-related quality of life (HRQL) in persons with epilepsy and support the reliability and validity of the QOLIE-89 regardless of method of administration.

Authors: Wong H, Smithen L.
Title: A case study of point-of-service medical use in a managed care plan.
Publication: Med Care Res Rev 56(Suppl 2):85-110.
Date: 1999
Abstract: This study examines the extent of point-of-service use in a managed care plan using 1990 and 1991 proprietary claims data (excluding pharmacy claims) from a large, well-established IPA with a point-of-service option. Our results show that approximately 12 percent of all claims were made by out-of-network providers, representing about 9 percent of the dollar value of all claims. This is about $131 per enrollee per year. While younger enrollees (i.e., 6-24 years) use fewer medical resources than do older enrollees, they tend to receive a greater share of their medical services from out-of-network providers. There is little difference between point-of-service use by males and females. Mental illness is the most common diagnosis for out-of-network claims, accounting for about 25 percent of the dollar value of out-of-network claims. 96 percent of the out-of-network claims for this diagnosis category were made by providers with a specialty in psychiatry.

Title: Pharmacoeconomics of antidepressant drug overdose.
Publication: CNS Drugs 10(3):223-31.
Date: 1998
Abstract: Patients with severe depression are often at risk of suicide, and many antidepressant medications are used, either alone or in combination with other substances, to attempt suicide. Drug overdoses involving antidepressants are known to result in significant medical costs to the healthcare system. The medical costs associated with an antidepressant drug overdose depend on the class and toxicity of the antidepressant and possible co-ingestants. Studies indicate that overdoses involving single Selective Serotonin Reuptake Inhibitors (SSRIs) have significantly lower medical costs compared with overdoses involving single TCAs.

Authors: Palmer CS, Revicki DA, Genduso LA, Hamilton SH.
Title: A cost-effectiveness clinical decision analysis model for schizophrenia.
Publication: Am J Managed Care 4(3)345-55.
Date: 1998
Abstract: A decision analytic Markov model was used to determine the cost-effectiveness of treatments and outcomes that patients treated for schizophrenia may experience over a 5-year period. Model parameter estimates were based on clinical trial data, published medical literature, and, when needed, clinician judgment. Direct medical costs were incorporated into the model, and outcomes were expressed by using three effectiveness indicators: the Brief Psychiatric Rating Scale, quality-adjusted life years, and lack of relapse.

Authors: Leidy NK, Palmer CS, Murray M, et al.
Title: Health-related quality of life assessment in euthymic and depressed patients with bipolar disorder: Psychometric performance of four self-report measures.
Publications: Journal of Affective Disorders 48:207-14.
Date: 1998
Abstract: The purpose of this study was to evaluate the psychometric properties of selected health-related quality of life (HRQL) self-report measures in 62 euthymic and depressed patients diagnosed with bipolar disorder. Patients completed the Quality of Life in Depression Scale, Mental Health Index-17, Cognitive Function Scale, and Medical Outcomes Study Short Form-36 at baseline and 8 weeks following treatment. Hamilton and Young Rating Scales were used to assess clinical status and validate the HRQL measures. Although the small sample size limits generalizability, euthymic and depressed outpatients with bipolar disorder appear to contribute reliable self reports on selected aspects of their quality of life.

Author: Brach C.
Title: Designing substance abuse and mental health capitation programs: A managed care guide for State and local officials.
Publication: Rockville (MD): Substance Abuse and Mental Health Services Administration.
Date: 1998
Abstract: This guide provides an overview of capitation and its goals for the substance abuse and mental health fields and defines 10 design decisions that must be analyzed when formulating a capitation program: identify goals, define populations eligible for enrollment, determine the scope of services, assign responsibilities for administration and delivery (integrated, mixed, or carved out), contracting, manage risk, set rates, market and enroll clients, assure quality, and implementation.
Availability: This guide can be ordered through the National Clearinghouse on Alcohol and Drug Information (NCADI) by calling 1-800-729-6686 or (301) 468-2600 or by E-mail

Authors: Friedman B, Devers K, Hellinger F, et al.
Title: Carve outs and related models of contracting for speciality care: Framework and highlights of a workshop.
Publication: American Journal of Managed Care 4(Special Issue).
Date: 1998
Abstract: This article provides an overview of papers presented at a workshop sponsored by AHCPR in January, 1998. The papers, published in this special issue of the American Journal of Managed Care, focus on one set of strategies: the use of carve outs and related models of contracting for specialty care. The defining common feature of these contracts is that they engage providers and management entities different from those otherwise available to care for the same patients within a health plan. The other common feature of these arrangements is that they receive significant attention in the marketplace and almost no attention from research. The purpose of the workshop and this special issue of the American Journal of Managed Care is to identify what is known and not known about these arrangements and develop an agenda for future research.
Availability: AHCPR Publication No. 98-R080 is available from the AHRQ Publications Clearinghouse.

Authors: Palmer CS, Revicki DA, Halpern MT, Hatziandreu EJ.
Title: The cost of suicide and suicide attempts in the United States.
Publication: Clinical Neuropharmacology 18(Suppl 3):S25-S33.
Date: 1995
Abstract: Suicide is ranked eighth as a cause of death in the United States and is the third leading cause of death in the 15- to 24-year age group. Schizophrenia, along with depression, is an important risk factor for suicide and attempted suicide. The incidence of suicide in 1994 was estimated, along with the 1994 projected costs of suicide and suicide attempts. Suicide attempts incur greater direct costs during hospitalization and a percentage of patients will suffer permanent disability requiring long-term care and loss of earnings; total costs averaged over $33,000 (U.S.) per attempt. Major cost savings may be achieved by targeting the prevention of suicide.

Authors: Robinson G, Brach C.
Title: Developing integrated mental health service delivery systems.
Publication: In Living in the Community with Disability: A Cross-Group Perspective, edited by V. Mor and S. Allen. New York, NY: Springer Publications.
Date: 1998
Abstract: This chapter discusses three methods for integrating mental health services for persons with severe mental illness living in the community: case management, capitation, and central authorities.

Authors: Brach C, Robinson G.
Title: Mental health.
Publication: In Health Care Choices for Today's Consumer: Families USA Guide to Quality and Cost, edited by M. Miller. New York, NY: Springer Publications.
Date: 1997
Abstract: This chapter in a popularly-sold consumer's guide provides advice on how to choose a provider and how to find appropriate care, and reviews the types of mental health services that are available and how to pay for them. The rights of mental patients are also delineated.

Authors: Jackson M, Spector W, Rabins P.
Title: Risk of behavior problems among nursing home residents in the United States.
Publication: Journal of Aging and Health 9(4):451-72.
Date: 1997
Abstract: This article represents the first report of risk factors associated with behavior problems in nursing homes in a nationally representative sample using multivariate techniques. The findings show, not surprisingly, that cognitive impairment is a major risk factor, but also show the importance of ADLs, incontinence, mobility and psychoses. Estimates are made separately for all behaviors, aggressive behaviors, collecting behaviors, wandering, and delusions and hallucinations.
Availability: AHCPR Publication No. 98-R011 is available from the AHRQ Publications Clearinghouse.

Author: Spector W.
Title: Measuring functioning in daily activities for persons with dementia.
Publication: Alzheimer Disease and Associated Disorders 11(Suppl):81-90.
Date: 1997
Abstract: This article evaluates the state of art of measuring functional disability with IADL and ADL scales for persons with dementia. Generic and dementia specific scales are compared. Among dementia specific scales, performance measures and proxy-respondent approaches are discussed. Recommendations are made for future research.
Availability: AHCPR Publication No. 98-R025 is available from the AHRQ Publications Clearinghouse.

Author: Brach C.
Title: Privatizing local mental health authorities and mental health services: Raising questions and considering options.
Publication: Boston (MA): Technical Assistance Collaborative, Inc.
Date: 1996
Abstract: This monograph, distributed to state and county mental health agencies, weighs the advantages and disadvantages of privatizing local mental health authorities and the relative merits to different organizational forms (quasi-public v. private non-profit corporation). The monograph also reviews considerations for privatizing the delivery of mental health services, and gives guidance on implementing either type of privatization strategy.
Availability: Select to access information on how to order this monograph on the Web site of the Technical Assistance Collaborative.

Authors: Brach C, Scallet L.
Title: Trends.
Publication: In Managed care: Challenges for children and family services, edited by Scallet L, Brach C, Steel E. Baltimore (MD): Annie E. Casey Foundation.
Date: 1996
Abstract: This report was designed to educate the systems that serve children and families (e.g., child welfare, special education, juvenile justice) about managed care. Drawing upon knowledge from the sectors where managed care is relatively more advanced, such as the health and mental health sectors, the authors discuss the implications of the advancement of managed care techniques into child- and family-serving systems.

Authors: Robinson G, Brach C.
Title: Managed mental health care and women: Implications of a changing delivery system.
Publication: Paper read at Changes in Mental Health Care: What Might They Mean for Women?
Date: October 2, 1996
Abstract: This article was written to serve as the basis of discussion for the Commonwealth Fund Commission on Women's Health's symposium, Changes in Mental Health Care: What Might They Mean for Women? The public mental health system is now undergoing a radical transformation with the advent of managed care. Over the past two decades Medicaid has grown into a dominant funding source for public mental health services. States, facing budgetary pressures, are increasingly shifting Medicaid programs into managed care.

Author: Spector W.
Title: Functional disability scales.
Publication: In Quality of Life and Pharmacoeconomics in Clinical Trials, edited by Spilker B. New York (NY): Lippincott-Raven Publisher.
Date: 1996
Abstract: This article reviews the major generic measures of functional disability including ADLs and IADLs used for adults. The scales are described, purpose and use are discussed, and the scales are evaluated in terms of the psychometric properties of the scale, evidence of reliability and validity, sensitivity to setting, and responsiveness to medical treatments. Approaches to combining ADL and IADL items are discussed.
Availability: AHRQ Publication No. 96-R053 is available from the AHRQ Publications Clearinghouse.

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